Women’s Experiences of the Effect of Financial Strain on Parenting and Mental Health

ObjectiveTo develop a conceptual theory to describe how financial strain affects women with young children to inform clinical care and research.DesignQualitative, grounded theory.SettingParticipants were recruited from the waiting area of a pediatric clinic and an office of the Special Supplemental Nutrition Program for Women, Infants, and Children embedded within the largest safety-net academic medical center in New England. Participants were interviewed privately at the medical center or in the community.ParticipantsTwenty-six English-speaking women, mostly single and African American/Black, with at least one child 5 years old or younger, were sampled until thematic saturation was met.MethodsWe used grounded theory methodology to conduct in-depth, semistructured interviews with participants who indicated that they experienced financial strain. We analyzed the interview data using constant comparative analysis, revised the interview guide based on emerging themes, and developed a theoretical model.ResultsFive interrelated themes emerged and were developed into a theoretical model: Financial Strain Has Specific Characteristics and Common Triggers, Financial Strain Is Exacerbated by Inadequate Assistance and Results in Tradeoffs, Financial Strain Forces Parenting Modifications, Women Experience Self-Blame, and Women Experience Mental Health Effects.ConclusionFor women with young children, financial strain results in forced tradeoffs, compromised parenting practices, and self-blame, which contribute to significant mental health problems. These findings can inform woman-centered clinical practice and advocacy interventions. Women’s health care providers should identify families experiencing financial strain, provide referrals to financial services, and join advocacy efforts to advance social policies that address the structural causes of poverty, such as increased minimum wage and paid family leave.     

Women's lived experience of compassionate midwifery: Human and professional

ObjectiveTo develop an understanding of women's lived experience of compassionate midwiferyDesignA qualitative study using the principles of Interpretive Phenomenological Analysis (IPA). Data was collected during interviews with 17 women who identified themselves as having received compassionate midwifery care.FindingsWomen participants' experience of compassionate care from midwives was experienced through a sense of a midwife Being With them, Being in Relationship with them and Empowerment. Women were also aware of the way midwives were able to Balance potentially conflicting aspects of their work, in order to provide compassionate care.Two other themes which emerged through extensive analysis of the data related to how women set their experience of compassion in the context of their personal suffering and that compassion made a difference. These themes will be reported separately.Conclusion and implications for practiceThe unique contribution of this study was to provide a window into the nature of women's lived experiences of compassionate midwifery and thus building, understanding around the qualities of compassionate midwifery and its impact on women. The findings are important because they challenge assumptions that compassion is ill-defined and therefore difficult to teach. On the contrary, compassionate midwifery was easily identified by women participants and had the features of an effective intervention for relieving their suffering. A dynamic model of Compassionate Midwifery in Balance has been proposed, providing a much-needed tool to inform practice, education and policy. Further research will build on this work by focussing on women in varied circumstances, environments and cultures and on understanding the lived experience of compassionate midwifery from the midwife's perspective.     

The experiences of women,midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis

Backgroundpregnant women, like all competent adults, have the right to refuse medical treatment, although concerns about maternal and fetal safety can make doing so problematic. Empirical research about refusal of recommended maternity care has mostly described the attitudes of clinicians, with women's perspectives notably absent.Designfeminist thematic analysis of in-depth, semi-structured interviews with women's (n=9), midwives’ (n=12) and obstetricians’ (n=9) about their experiences of refusal of recommended maternity care.Findingsthree major interrelated themes were identified. “Valuing the woman's journey”, encapsulated care experiences that women valued and clinicians espoused, while “The clinician's line in the sand” reflected the bounded nature of support for maternal autonomy. When women's birth intentions were perceived by clinicians to transgress their line in the sand, a range of strategies were reportedly used to convince the woman to accept recommended care. These strategies formed a pattern of “Escalating intrusion”.Key conclusions and implications for practicedeclining recommended care situated women at the intersection of two powerful normative discourses: medical dominance and the patriarchal institution of motherhood. Significant pressures on women's autonomy resulted from an apparent gap between clinicians’ espoused and reported practices. Implications for policy and practice include a need for specific guidance for clinicians providing care in situations of maternal refusal, the potential value of an independent third-party for advice and advocacy, and the development of models that support reflexive practice amongst clinicians.     

Qualitative,Interpretive Metasynthesis of Women’s Experiences of Intimate Partner Violence During Pregnancy

ObjectiveTo describe the perspectives of women who experienced intimate partner violence (IPV) during pregnancy through a qualitative, interpretive metasynthesis.Data SourcesWe searched 12 electronic databases to identify articles on qualitative studies pertaining to women’s experiences of IPV during pregnancy. We searched Academic Search Complete, AgeLine, CINAHL Complete, Family Studies Abstracts, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences, PsycINFO, Social Work Abstracts, Health Source–Consumer Edition, Health Source–Nursing/Academic Edition, and Humanities Full Text for articles published from 2008 through 2018.Data ExtractionWe used inclusion and exclusion criteria to identify eight reports of qualitative studies that contained direct quotations in which women described their experiences of IPV.Data SynthesisWe used a methodologic reduction to provide a theoretical context that helped us synthesize the data to five key themes: Pregnancy Escalates Abuse, Concern for Unborn Fetus, Importance of Support, My Child Saved Me, and Pregnancy Is a Catalyst for Reflection.ConclusionThe results of our synthesis illustrate the unique perspectives of women who experienced IPV during pregnancy. Understanding these experiences can help health care providers assist pregnant women through enhanced screenings and education. Health care providers can also help women identify resources for emotional and financial support as they determine the best courses of action for themselves and their children.     

Views on Exercise Among Black Women During Pregnancy

ObjectiveTo describe and understand exercise practices, beliefs about exercise, support for exercise, barriers to exercise, and preferences for a group exercise program in the context of individual and environmental factors among Black women during pregnancy.DesignMixed-methods design.SettingLarge university-affiliated urban midwifery practice.ParticipantsFourteen Black women who were pregnant.MethodsWe conducted semistructured interviews to determine participants’ exercise practices, beliefs about exercise while pregnant, exercise support and barriers, and preferences for a group pregnancy exercise program. Participants also completed self-report measures for exercise, neighborhood environment, symptoms of depression, and sociodemographic characteristics. We used matrices to facilitate integrated analysis of the interview and self-report data to determine areas of concordance and discordance among the data sources and to note patterns in the data.ResultsWe identified and described themes that represented concepts in our data: Exercise Misinformation and Folklore, Support for Exercise While Pregnant, Barriers to Exercise While Pregnant, Perceived Health Benefits, and Exercise Program Preferences. Data diverged for some participants on neighborhood as a barrier to exercise. Except for the two participants with high levels of symptoms of depression, data converged regarding symptoms of depression as a barrier to exercise.ConclusionHealth care providers can successfully promote exercise if they provide education about exercise during pregnancy, help pregnant women overcome barriers to exercise, prompt women to exercise with partners for tangible and social support while pregnant, and refer women to exercise programs for pregnant women if available.     

Lived experiences of women with co-existing BMI≥30 and Gestational Diabetes Mellitus

Objectiveto explore the lived experiences of women with co-existing maternal obesity (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM) during pregnancy and the post-birth period (<3 months post-birth).DesignA qualitative, sociological design was utilised. Data were collected using a series of sequential in-depth narrative interviews during pregnancy and post-birth and fieldnotes. Cross sectional thematic analysis of the data set was undertaken, alongside the construction/analysis of in-depth biographical longitudinal case profiles of individual participants.SettingParticipants were recruited from diabetic antenatal clinics at two NHS hospital trusts in the South West of England.Participants: 27 women with co-existing BMI ≥ 30 and GDM. Participants were predominantly of low socio-economic status (SES).FindingsWomen were experiencing a number of social and economic stressors that compromised their ability to manage pregnancies complicated by maternal obesity and GDM, and make lifestyle changes.Women perceived themselves to be stigmatised by healthcare professionals and the general public due to their obese and gestational diabetic status.Key conclusionsWomen of low SES with maternal obesity and GDM perceived healthcare professionals' recommendations with respect to lifestyle change as unrealistic given their constrained social/material circumstances. Frequent references to weight/lifestyle change by different HCPs were seen as stigmatising and may be counterproductive.Implications for practiceWomen would like more collaborative care which acknowledges/addresses their personal and financial circumstances. Multidisciplinary teams should give consideration to how, by whom, and the frequency with which issues of weight/lifestyle change are being discussed in order to avoid women feeling stigmatised.     

Narrative Inquiry Into Nursing Care of Pregnant Women and Families in Specialized Fetal Diagnosis and Treatment Settings

ObjectiveTo examine how nurses describe caring for women and families in specialized fetal diagnosis and treatment settings.DesignWe used narrative inquiry.SettingA secure online survey platform.ParticipantsWe recruited 26 nurses from the Fetal Therapy Nurse Network as a subsample from a prior Delphi study on the essential structures, processes, outcomes, and challenges of nursing practice in the emerging field of fetal diagnosis and treatment.MethodsWe used narrative inquiry and Clandinin’s three-dimensional space narrative analysis to interpret the stories provided by participants to illustrate their practice and the relationship between their practice and care quality and health outcomes.ResultsParticipants described three primary types of fetal diagnoses and management scenarios: prenatal intervention (maternal–fetal surgery to treat a fetal anomaly), postnatal intervention (neonatal surgery), and perinatal palliative care (continuation of a pregnancy after a life-limiting fetal diagnosis). We identified three overarching themes related to nursing processes: A Sounding Board: Counseling the Pregnant Woman and Family, A Care Coordinator: Orchestrating a Complex Journey, and A Constant Presence: Being With the Pregnant Woman and Family. We also identified specific outcomes related to nursing care.ConclusionWe used narrative inquiry to expand on prior research and advance the conceptualization of a model of nursing practice in fetal diagnosis and treatment settings. Our results provide a basis to begin to test theories that connect nursing practice to care quality and outcomes in clinical practice settings. To comprehensively evaluate and enhance care as it evolves and expands, the immediate and long-term effects of nursing practice must be identified.     

Experiences of Surgical Continence Management Approaches for Cloacal Anomalies: A Qualitative Analysis Based on 6 Women

Study ObjectiveThe aim of this qualitative study was to gain insight into health care experiences of young women diagnosed with cloacal anomalies, with a special focus on continence management.DesignQualitative analysis of one-to-one interviews.SettingA tertiary center for congenital anomalies of the urogenital tract in London.ParticipantsSix women aged 16 to 24 with cloacal anomalies.InterventionsTape-recorded one-to-one semi-stuctured interviews with a skilled interviewer.Main Outcome Measure(s)The taped interviews were transcribed and analyzed verbatim using interpretative phenomenological analysis according to the research question. Organizing themes across all of the accounts were identified.ResultsTwo organizing themes concerning our research interests are summarized. The first theme Personal Agency in the Hands of Experts focuses on the interviewees’ appreciation of their life-saving surgical care and their involvement in treatment decisions. The second theme Compromises and Trade-Offs focuses on what it was like to live with the more traditional versus the more advanced continence methods. Reliability emerged as a key priority in terms of continence treatment outcome. Gratitude may have interfered with the women’s honest communications during treatment decision and evaluation consultations.ConclusionsA more developed approach to communication about the complex interventions proposed, founded on a nuanced understanding of users perspectives, can enhance informed decision making about continence management approaches. Despite these specific gaps, the interviewees were appreciative of their care and optimistic about life.